New Survey Reveals Physicians Support a Hybrid Health Care System

BOSTON, Oct. 22, 2020 /PRNewswire/ -- The Physicians Foundation, a national nonprofit advancing the work of practicing physicians to support the delivery of high-quality patient care, today released the results of a national survey of 1,270 physicians on the future of the health care system. When asked to rank their preferences for the future direction of the U.S. health care system, physicians ranked a two-tiered system featuring a single payer option plus private pay as the best direction. As part of the same question, physicians overwhelmingly ranked a government funded and administered single payer/Medicare for All system lowest among four potential options. The survey, COVID-19 And The Future Of The Health Care System, is the third in the Foundation's three-part series, 2020 Survey of America's Physicians, examining how COVID-19 is affecting and is perceived by the nation's physicians.

The survey also asked physicians to rank a series of policy steps that would ensure access to high-quality, cost-efficient care. Physicians overwhelmingly indicated that efforts to "simplify/streamline prior authorization for medical services and prescriptions" was the most important thing that could be done to ensure access to care. Reimbursing physicians for providing telemedicine services and simplifying access to integrated mental health services each were tied as the next most popular choices.

"As we've seen from our data over the past few months, COVID-19 has had a tremendous impact on physicians. We know that burnout continues to grow as a result of frustration with the pandemic and our current health care system, and you see that in this survey's results," said Gary Price, MD, president of The Physicians Foundation. "Physicians are fed up with being unable to practice medicine the way they were trained to do so. They are tired of fighting insurers and PBMs to get patients the treatments they need, and they want change. They want to be able to offer the services patients need and want."

Direction of the Health Care System

While physicians' overall preference is for a hybrid approach, their opinions on other options for organizing our system yielded significant insights. Most surprisingly, maintaining or improving the current Affordable Care Act (ACA) influenced program did not initially rank high, with only 19% selecting this as number one on the one to four scale. Instead, 30% of physicians (the second highest percentage) chose moving to a market-driven system with Health Savings Accounts (HSAs) and catastrophic policies as number one. It wasn't until the next levels (two to four) were added that improving the current ACA system became more highly ranked (49%) than transitioning to a market-driven/HSA model (45%). The survey found significant polarity in support for HSAs: thirty percent of physicians rated it a number one, but 42% also rated it a four.

Support for a "single payer/Medicare for All" type of system consistently scored last with physicians, who rated the option either one through three. The only time is was not the least preferred option was among level four ratings, in which it was surpassed by HSAs 42% to 38%.

Q. Considering all relevant issues such as patient access, value and quality, health system efficiency, physician autonomy and compensation, and the COVID-19 public health response, what direction should the health care system take?  Rank the options below 1-4, with 1 being the best approach.  

	1	2	3	4
Maintain/improve the current ACA influenced system	19%	30%	39%	12%
Implement a single payer/Medicare for All system (government funded and administered)	19%	21%	22%	38%
Implement a two-tiered system (single payer available for all, with private pay/insurance option)	36%	31%	22%	11%
Move to a market-driven system with Health Savings Accounts	30%	15%	13%	42%

Patient Access to Care

Physicians agree there are immediate policy steps that must be undertaken to ensure high-quality, cost-efficient care for all. Sixty percent cite streamlining/simplifying prior authorizations, 56% report simplifying access to mental health services and 54% of physicians said that providing insurance coverage for the diagnosis and treatment of COVID-19 were extremely important steps.

When considering the future of the health care system over the next two to five years, 64% of physicians rank providing affordable health insurance as extremely important to ensuring high-quality, cost-efficient care for all, followed by 55% of physicians who ranked increasing the number of physician leaders as extremely important.

"Our current health care system is directed by policymakers and business executives, instead of physicians," said Robert Seligson, CEO of The Physicians Foundation. "Physicians are the foundation of health care, and as such they know what is best for our system, and the patients they serve. These data provide a clear picture of what physicians want to see in our health care system. It's critical these insights are included in any and all health care reform discussion if we hope to improve access to quality care."

Social Determinants of Health

When looking to the future, investing in social determinants of health (SDOH) is top of mind for America's physicians. In the next two to five years, 44% of physicians strongly agree that reducing health inequity/inequality of access will ensure high-quality, cost-efficient care for all.

In addition, 34% of physicians strongly agree that SDOH, such as access to healthy food, transportation and safe housing will drive demand for health care services in 2021. Furthermore, 38% of physicians strongly agree that patient problems accessing healthy food, safe housing or other SDOH should be included in the risk scoring that insurance companies use to determine patient complexity.

"Independent physicians have been emotionally and financially drained from COVID-19. As we recover during these uncertain times, physicians' voices need to be heard," said Ripley Hollister, MD, a board member and chair of The Physicians Foundation's Research Committee. "This is our chance to get it right, not only for our physicians but for the patients they serve and the overall health care system."

Additional findings from the survey include:

• Nearly half (44%) of physicians indicate that 26% of their patients delay or decline care due to costs
• Seventy percent of physicians strongly agree that chronic conditions such as heart disease, diabetes and kidney disease will place a high demand on our health care system in 2021
• Forty-two percent strongly agree that conditions worsened by the pandemic induced delays will place a high demand on our health care system in 2021
• Forty-five percent of physicians strongly agree that establishing price transparency for medical services in the next two to five years will ensure high-quality, cost-efficient care for all

This survey was conducted for The Physicians Foundation by Merritt Hawkins. For the full results: https://physiciansfoundation.org/wp-content/uploads/2020/10/2020-Physicians-Foundation-Survey-Part3.pdf

About The Physicians Foundation
The Physicians Foundation is a nonprofit seeking to advance the work of practicing physicians and help them facilitate the delivery of high-quality health care to patients. As the health care system in America continues to evolve, The Physicians Foundation is steadfast in its determination to strengthen the physician-patient relationship and assist physicians in sustaining their medical practices in today's practice environment. It pursues its mission through a variety of activities including grant-making, research, white papers and policy studies. Since 2005, the Foundation has awarded numerous multi-year grants totaling more than $50 million. In addition, the Foundation focuses on the following core areas: physician leadership, physician wellness, physician practice trends, social determinants of health and the impact of health care reform on physicians and patients. For more information, visit www.physiciansfoundation.org.

About Merritt Hawkins
Merritt Hawkins is the leading physician search and consulting firm in the United States and is a company of AMN Healthcare (NYSE: AMN). AMN Healthcare is the leader and innovator in total talent solutions to health care organizations across the nation, providing access to the most comprehensive network of quality health care professionals through its innovative recruitment strategies and breadth of career opportunities. For more information, visit www.merritthawkins.com and www.amnhealthcare.com.

Survey Methodology  
The Physicians Foundation's 2020 Survey of America's Physicians: COVID-19 Impact Edition -Part Three of Three: COVID-19 And The Future Of The Health Care System was sent by email to a list of physicians derived from an American Medical Association/Physician Master File approved vendor, and to physicians in Merritt Hawkins' proprietary data base. The survey was sent from September 14 to September 28, 2020. It was received by more than 500,000 physicians nationwide. Data is based on 1,270 responses, with a margin of error (MOE) of +/- 2.87%.  

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SOURCE The Physicians Foundation